Category Archives: Hispanic Health

By Eyob Mazengia, PhD, RS, Food Protection Program
Public Health – Seattle & King County

When I started as a food inspector, I was assigned to the International District. And I liked it. It was almost like walking into a new culture, a new era.

What fascinated me was that as a public health worker, I had permission to walk into people’s personal spaces. I liked the smells, the sounds of their languages, their wall hangings and the way things looked.

It was a privilege, really, to be allowed into their personal spaces. Going on food inspections in the I.D., it was like walking into 3-4 different countries every day, without traveling outside the neighborhood.

Over the years, I established good relationships with the restaurant establishments. They were no longer just restaurant operators—they were mothers, fathers, grown kids. They’re not just businesses—there’s a family behind every door, people who had often gone through difficult times to be here.

And as I got to know them, I could recognize the sacrifices they made to give their children better opportunities in the U.S., and what they left behind. Even those born and raised here, you could recognize the sacrifices they were making. Continue reading →

International Community Health Services (ICHS) been cited by the federal government as a “National Quality Leader” for exceeding national clinical benchmarks for chronic disease management, preventive care, and perinatal/prenatal services.

The Seattle-based health center also was recognized for achieving some of the best overall clinical outcomes nationally for health centers and for showing significant improvement in clinical quality measures between 2012 and 2013.

ICHS is a non-profit community health center that specializes in providing affordable health care services to Seattle and King County’s Asian, Native Hawaiian, Pacific Islander, and other underserved communities.

It operates medical and dental centers in Seattle’s International District and Holly Park neighborhoods, as well as in the cities of Bellevue and Shoreline; a school-based health center at the Seattle World School, and a primary care clinic at ACRS, a social and mental health services agency in Seattle.

In recognition of its accomplishment and to fund further quality improvement, ICHS will receive $84,169 in Affordable Care Act funding by the U.S. Department of Health and Human Services.

In the country’s unhealthiest state, the failure of Obamacare is a group effort.

By Sarah VarneyKHN / October 29, 2014

The lunch rush at Tom’s on Main in Yazoo City, Mississippi, had come to a close, and the waitresses, having cleared away plates of shrimp and cheese grits, seasoned turnip greens and pitchers of sweet tea, were retreating to the counter to cash out and count their tips.

It didn’t take long: The $6.95 lunchtime specials didn’t land them much, and the job certainly didn’t come with benefits like health insurance. For waitress Wylene Gary, 54, being uninsured was unnerving, but she didn’t try to buy coverage on her own until the Affordable Care Act forced her to. She didn’t want to be a lawbreaker.

Months earlier, she had gone online to the federal government’s new website, signed up and paid her first monthly premium of $129. But when her new insurance card arrived in the mail, she was flabbergasted.

“It said, $6,000 deductible and 40 percent co-pay,” Gary told me at the check-out counter, her timid drawl giving way to strident dismay. Confused, she called to speak to a representative for the insurer Magnolia Health. “’You tellin’ me if I get a hospital bill for $100,000, I gotta pay $40,000?’ And she said, ‘Yes, ma’am.’”

Never mind that the Magnolia worker was wrong — her out-of-pocket costs were legally capped at $6,350. Gary figured with a hospital bill that high, she would have to file for bankruptcy anyway. So really, she thought, what was the point?

“This ain’t worth a tooth,” she said.

She canceled her coverage.

The first year of the Affordable Care Act in Mississippi was, by almost every measure, an unmitigated disaster. In a state stricken by diabetes, heart disease, obesity and the highest infant mortality rate in the nation, President Barack Obama’s landmark health care law has barely registered, leaving the country’s poorest and perhaps most segregated state trapped in a severe and intractable health care crisis. Continue reading →

Nationality at birth appears to play a significant role in whether or not adults in the United States are routinely vaccinated for preventable diseases, a new study in the American Journal of Preventive Medicine finds, reflecting a risky medical lapse for more than one in ten people nationwide.

Foreign-born adult U.S. residents, who make up about 13 percent of the population, receive vaccinations at significantly lower rates than U.S.-born adults.

Foreign-born adult U.S. residents make up about 13 percent of the population.

This gap poses special risks for certain groups of people who are vulnerable to many serious and sometimes deadly diseases that vaccines can prevent.

The study’s lead author, Peng-Jun Lu, MD, PhD, a researcher at the Center for Disease Control and Prevention, noted the rise in the foreign-born population in the United States, which stood at only five percent in 1970.

“As their numbers continue to rise, it will become increasingly important to consider this group in our efforts to increase vaccination and eliminate coverage disparities,” he said. Continue reading →

In the “sala de espera,” or waiting room, at La Clinica del Pueblo, a community health center in Washington, D.C., signs in Spanish encourage patients to “Empower yourself!” and sign up for insurance coverage through the Affordable Care Act.

Adults slump in chairs, scribbling on application forms, texting friends, waiting. In a tiny office a few feet away, William Joachin, the center’s patient access manager, faces down the frustrations of trying to navigate the federal health care program for the thousands of mostly Central American immigrants who flood the clinic each year. He’s not alone.

A year after open enrollment for the ACA began, one in four Latinos living in the U.S. does not have health insurance, according to new census data, more than any other ethnic population in the country—and most states have few backups in place to help those in the coverage gap.

Latino immigrants are the hardest hit: Foreign-born Hispanics are more than twice as likely to be uninsured than are U.S.-born Hispanics, according to census data compiled by the Pew Research Center. (Pew also funds Stateline.)Continue reading →

In a highly anticipated ruling, a federal judge in Austin struck down part of a Texas law that would have required all abortion clinics in the state to meet the same standards as outpatient surgical centers.

The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

“. . . state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women.”

The regulation, which was set to go into effect Monday, would have shuttered about a dozen abortion clinics, leaving only eight places in Texas to get a legal abortion — all in major cities.

Judge Lee Yeakel ruled late Friday afternoon that the state’s regulation was unconstitutional and would have placed an undue burden on women, particularly on poor and rural women living in west Texas and the Rio Grande Valley.Continue reading →

Jessie Yuan, physician at the Eisner Pediatric & Family Health Center in Los Angeles, treats diabetic patient Oscar Gonzales. Gonzalez was unaware he had been switched to Medi-Cal until Yuan informed him about the change (Photo by Anna Gorman/KHN).

In a push to cover immigrants excluded from the nation’s health reform law, a California state senator has proposed legislation that would offer health insurance for all Californians, including those living here illegally. Continue reading →

During the month of October, Snohomish Health District will present a National Latino AIDS Awareness campaign aimed at engaging the Hispanic/Latino community in promoting HIV awareness through testing, prevention and education.

This year’s theme is “Commit to Speak”/“Comprométete a Hablar.”

In Washington state, 12% of all individuals currently living with HIV/AIDS are Latino – but Latinos only compromise approximately 9.4% of the total population.

The rates of new infections among Latino men were more than double that of white men. The rate of HIV infection among Latino women was nearly four times that of white women.

To address this disparity and increase awareness, staff from the Snohomish Health District will be offering free testing at community locations to members of the Latino and general communities who qualify based on their risk factors:

The Centers for Disease Control and Prevention states the impact of HIV on Hispanics/Latinos is not directly related to race or ethnicity, but rather to challenges faced by some communities, including less awareness of HIV status, poverty, access to care, stigma, migration acculturation (the process of adopting the cultural traits or social patterns of another group) and homophobia.

The Health District offers free and confidential HIV testing and counseling for high-risk individuals year-round, in our Everett clinic location, with test results in 30 minutes. Individuals with risk can also be tested for hepatitis A,B, C, and syphilis. For information about HIV/AIDS prevention and testing, call the Health District at 425.339.5298, or visit www.snohd.org.

By Lornett Turnbull, The Seattle TimesThis story was produced in partnership with

Photo: Willi Heidelbach

Likos Afkas is a native of the Federated States of Micronesia, part of a cluster of islands in the Pacific where nuclear testing by the U.S. government during the Cold War left behind high rates of cancer.

Together with neighboring Palau and the Marshall Islands, the Federated States of Micronesia has a special compact with the U.S. under which its people, heavily recruited by the U.S. military, can live and work here indefinitely — but as noncitizens, they are denied certain federal benefits.

Afkas, 48, first came to the U.S. a year ago, suffering from diabetes and heart problems, and was immediately diagnosed with kidney failure that requires three-times-a-week dialysis.

Last month, he was notified that he lacked sufficient job credits to continue receiving the Medicare coverage he’s depended on to cover some of his medical bills.

Now, like untold numbers of his countrymen and other immigrants, Afkas is taking stock of his health-care options as the clock counts down to the Oct. 1 opening day for enrolling in health coverage under the federal government’s Affordable Care Act (ACA). Coverage begins Jan. 1.

“If I go back home, I’d only be going back to die.”

For him, the prospects aren’t promising.

Ultimately, how he and other immigrants fare under this massive health-care overhaul will depend on many factors: their income, immigration status, how long they’ve lived in this country and — in the case of people like Afkas — their country of origin.

While his household income would otherwise qualify him for Medicaid, the primary option under ACA for delivering health coverage to low-income people, Afkas’ immigration status makes him ineligible.

He worries he’ll be required to buy health insurance under the law or face a penalty — neither of which he says he can afford. However, he is likely exempt from that requirement if the cost of insurance premiums would be more than 8 percent of his household income, or if he makes so little that he doesn’t file a tax return.

Returning to Chuuk, his home state in Micronesia, is not an option, he said, because of the woefully inadequate health system there.

“If I go back home, I’d only be going back to die.”

Lacking insurance

The health-care-overhaul law, commonly known as Obamacare, targets people who lack health insurance — an estimated 1.09 million residents of Washington state.

It’s unclear what percentage of them are immigrants.

Studies have shown that in general, immigrants tend to be healthier than the rest of the population — they are younger and are subject to medical examination to obtain green cards — though many of the same studies also suggest they become less healthy over time.

“There are some people who have gotten used to being uninsured, so we need to provide a whole other level of information about why they’d even want to be insured now that it’s available to them,” said Michael McKee, health-services director of theInternational Community Health Services, whose clinics serve large numbers of immigrants.

“Part of it is also helping them understand the penalties,” he said. “That’s going to be totally new to everybody.”

As complicated as the law will be for the average American, immigrant advocates worry it will be even more daunting for those whose primary language is not English and for whom regular visits to a doctor are not a cultural tradition.

“We look at access to care and coverage as opportunities to address health disparities,” McKee said. “It’s incumbent on us to educate people on the importance of preventive care and healthy options so they can avoid some of the costly outcomes.”

Options for uninsured

Under the ACA, the majority of the state’s uninsured will be required to buy health-care coverage, or face a penalty.

Those with the lowest income — about a third — will qualify for Medicaid, the free or near-free health-insurance program that will be expanded under Obamacare to deliver health care to the poorest Americans.

How and where immigrants fit into all this are questions many advocacy groups continue to unravel.

“I don’t think there’s any question the majority of immigrants will benefit from this,” said Jenny Rejeske, policy analyst for the National Immigration Law Center. “It’s going to require vigilance from advocates and people who want this to work. It’s not going to be perfect on day one.”

Mary Wood, section manager at Washington State Health Care Authority, said the rules related to immigrants’ eligibility for Medicaid under the health law haven’t changed: If their immigration status made them ineligible before the law took effect, they’ll remain ineligible.

U.S. citizens and legal permanent residents or green-card holders who have been in this country for five years or longer will be treated the same as U.S.-born citizens when it comes to coverage. They can apply for Medicaid under the program’s broadened guidelines if their income is low enough.

Other types of immigrants will also qualify regardless of how long they’ve been in this country: asylum seekers and refugees, special immigrants from Iraq and Afghanistan, victims of trafficking and immigrants who served in the armed services.

They will be among an estimated 250,000 people who state officials estimate will become newly eligible under the expanded Medicaid limits for those with incomes up to 138 percent of the federal poverty level — or $15,856 for a single person.

Meanwhile, other legal immigrants — those with higher incomes or those here for fewer than five years, people temporarily in this country, such as students and work-visa holders, as well as people like Afkas — won’t qualify for Medicaid.

Those among them with incomes between 139 and 400 percent of the federal poverty level — $45,960 for a single person — will qualify for subsidies and tax credits to help cover insurance premiums.

And all low-income children, regardless of their immigration status, will be covered under any number of federal and state health care programs.

Unlawful residents

For adults in the country unlawfully, the government has little to offer.

While most undocumented immigrants work in jobs that do not provide health insurance, it is estimated that 25 percent of them do have coverage.

Still, undocumented immigrants account for about 14 percent of Washington state’s uninsured. And those with no coverage — an estimated 127,530 — will continue to go without.

Undocumented adult immigrants are unable to participate in Medicaid or Medicare and that won’t change. They are also ineligible to purchase from the health exchange. But unlike most other groups, they won’t face a penalty for not having insurance.

There is coverage available for low-income women during pregnancy regardless of their immigration status, and like everyone else, undocumented immigrants continue to qualify for emergency care under federal law.

And those whose incomes would otherwise entitle them to Medicaid but for their immigration status can qualify for emergency Medicaid for emergent conditions, such as heart attacks.

Particular status

And then there are people like Afkas, whose status most Americans do not know.

Micronesia, Palau and the Marshall Islands are former United Nations trust territories, which the U.S. Navy administered between 1947 and 1951.

Today, they are sovereign nations, each with a Compact of Free Association with the United States under which their people can work and live in this country indefinitely, though they are neither U.S. citizens or nationals.

In 1996, when Congress reformed welfare, it barred most legal immigrants from Medicaid and other federal health programs for the first five years of residency. It also indefinitely barred those from the compact states from receiving Medicaid.

Many use their immigration privilege to seek treatment — mostly state-funded — for the cancer and other health problems plaguing their countries, usually in Hawaii, but increasingly in places like Washington state, said Xavier Maipi, who runs a nonprofit agency to advocate for residents from compact countries.

An estimated 2,000 — mostly Marshallese and Micronesians — live here.

Afkas lived on the island state of Chuuk in Micronesia before he came to the Seattle area a year ago, his health failing.

Already suffering heart problems and diabetes, he was diagnosed with kidney failure at Seattle’s Harborview Medical Center, whose reputation as a source for indigent care he and others say has become well known in the islands.

The medical bill for his monthlong stay totaled $100,000, which Medicare covered.

But in July, Afkas was notified he lacked sufficient job credits to continue receiving $700 in monthly Supplemental Security income and Medicare.

He’ll continue to receive weekly dialysis through a state program geared to those whose immigration status disqualifies them for Medicaid but will have to go uncovered for everything else.

Afkas’ wife earns a small amount to provide home health care for him from another part of the same program that covers his dialysis. “Right now, I don’t know what I’m going to do,” he said.

Like many people, he doesn’t know much about the Affordable Care Act and hasn’t given it much thought. Paying for health insurance — any amount — isn’t in the household budget.

“Many of these folks are simply trying to survive,” Maipi said. “For health care, they go to the emergency room — and usually that’s when they’re at death’s door.”

‘A lot of questions’

Immigrant advocates know they face a daunting task preparing clients and constituents for the coming change.

While information about the exchange will be available in eight different languages, thewebsite the public will use to sign up for care will be available only in English and Spanish.

“Many of our clients are refugees and immigrants and 60 percent of them have limited English proficiency,” McKee said.

Health clinics like his and other federally funded health centers that now serve anyone who walks through their doors will continue to do so — regardless of their insurance status or ability to pay.

“This is the largest sea change in public policy since Social Security,” McKee said.

“Everyone wants to get it right. And at the end of the day, there will be a lot of questions and the hope is that we can, with this first run, enroll as many people who will benefit.”

Seattle Times reporter Carol M. Ostrom contributed to this report.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

New state restrictions on clinics that provide abortions could leave millions of women—many of them poor and uninsured—without easy access to cancer screenings and other basic health care services.

In recent years, abortion opponents have tried to limit abortions by barring them after a certain number of weeks and by requiring women who want to end their pregnancies to have ultrasounds. Those strategies target abortion directly.

Now abortion opponents in some states are pushing for new standards for clinics, such as requiring doctors to have admitting privileges at a nearby hospital, that may be difficult or impossible for them to meet.

Abortion rights supporters fear the new rules could force many clinics to close—a result that would make it more difficult for women to get a broad array of health care services, not just abortions.

“Every time a clinic closes, the women who would be using those clinics, it’s not as if those women stop existing,” said Kimberly Inez McGuire of the National Latina Institute for Reproductive Health, an advocacy group. “It will affect whether women can get cancer screenings, whether women can get to a provider to get their blood pressure checked.”

“Clinics that serve women who may not have insurance are literally a lifeline,” McGuire said.

Fifteen states now require clinic doctors to have hospital admitting privileges, according to the Guttmacher Institute, which supports abortion rights.

In addition, 26 states require abortion-providing clinics to meet surgical facility standards, which stipulate everything from the size of certain rooms, the types of light switches used and the width of hallways.

Supporters say such requirements are common-sense public health measures. They cite high-profile examples of poor oversight and gruesome malpractice cases, most notably the Kermit Gosnell case in Philadelphia.

“What is so wrong about having high health standards in place?” asked Alabama Rep. Mary Sue McClurkin, who sponsored legislation which includes clinic regulations and requirements for doctors that has been blocked by a federal judge. “If they would just do what was in the best interest of the patient, it would not be a problem.”

Opponents of such laws say they might close a vital health care entryway for women. In many states, the clinics offer services ranging from sexually transmitted disease testing and treatment to mammograms, Pap tests and cancer screenings.

They also offer family planning counseling and birth control services—in many cases at reduced fees for the uninsured.

In 2011 and 2012, the Guttmacher Institute conducted a survey of women receiving services at family planning centers located in communities in which there were other health care options.

About four in 10 women said they used a clinic as their exclusive health care provider in the past year. Among other reasons, the women said they preferred going to a clinic because staff there knew more about women’s health and it was easier to talk to them about sex.

The connection between the clinics, public health care programs and women’s health was further underscored by a Kaiser Family Foundation study.

The report noted that in many states, there are few providers willing to accept Medicaid or other subsidized insurance programs. In those places, the clinics are a vital, and sometimes the only, option for low-income people.

Prior to the funding cut-off, those centers were caring for nearly 50,000 patients. The program served 63 percent fewer women the year after the cuts, state data showed.

The American Congress of Obstetricians and Gynecologists has also argued that clinic closings could damage women’s health. The group blasted Texas’ new abortion law and measures under consideration in North Carolina.

Those who back the laws argue the regulations would make the clinics safer.

So far, courts haven’t bought that argument, seeing laws that could shutter clinics as potentially unconstitutionally restrictive of abortion.

Courts already have blocked physician requirements in Mississippi and Alabama. Last week, Wisconsin’s law was temporarily blocked by a federal judge and advocates are preparing to fight Texas’ law as well.

“The courts have seen right through the arguments that this is somehow supposed to protect women’s health,” said Julie Rikelman of the Center for Reproductive Rights, which is involved in the legal fights. “These laws really hurt women’s health, not help them.”

Stateline is a nonpartisan, nonprofit news service of the Pew Center on the States that provides daily reporting and analysis on trends in state policy.

Post navigation

Welcome

LocalHealthGuide is a health news and information web service for Seattle and the Puget Sound Region. We are independent and unaffiliated with any hospital, medical association or insurer. If you have questions or if your group has an upcoming event that you would like us to cover, please let us know by going to our "Contact Us" page and dropping us a note. -- Michael McCarthy, Editor

Washington is one of the handful of states that established their own exchange marketplace, known as Washington Healthplanfinder, putting it outside the group of states targeted in the King v. Burwell case — those that use the federal exchange called HealthCare.gov.

On Monday, a team of researchers tracing the history of HIVsaid that the virus originated in humans on 13 separate occasions, evolving in humans from ancestral viruses that infected monkeys, chimpanzees and gorillas.